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Abstract Background: Only a fraction of patients with cutaneous lupus erythematosus (CLE) will eventually progress toward systemic disease (SLE). Objective: To find inflammatory biomarkers which could predict the progression of cutaneous lupus erythematosus (CLE) into systemic lupus erythematosus (SLE) using immunohistochemical (IHC) assays. Methods: Immunohistochemical markers for cytotoxic, inflammatory, and anti-inflammatory responses and morphometric methods were applied to routine paraffin sections of skin biopsies, taken from lesions of 59 patients with discoid lupus, subacute lupus, and lupus tumidus. For the diagnosis of SLE, patients were classified by both the American College of Rheumatology (ACR-82) and the Systemic Lupus International Collaborating Clinics (SLICC-12) systems. Results: Skin samples from CLE/SLE +patients presented higher expression of IL-1β (ARC-82: p = 0.024; SLICC-12: p = 0.0143) and a significantly higher number of cells marked with granzyme B and perforin (ARC: p = 0.0097; SLICC-12: p = 0.0148). Biopsies from CLE/SLE- individuals had higher expression of IL-17 (ARC-82: p = 0.0003; SLICC-12: p = 0.0351) and presented a positive correlation between the density of granzyme A+and FoxP3+ cells (ARC-82: p = 0.0257; SLICC-12: p = 0.0285) and CD8+ cells (ARC-82: p = 0.0075; SLICC-12: p = 0.0102), as well as between granulysin-positive and CD8+ cells (ARC-82: p = 0.0024; SLICC-12: p = 0.0116). Study limitations: Patients were evaluated at a specific point in their evolution and according to the presence or not of systemic disease. The authors cannot predict how many more, from each group, would have evolved towards SLE in the following years. Conclusions: In this cohort, immunohistochemical findings suggested that patients with a tendency to systemic disease will show strong reactivity for IL-1β, while those with purely cutaneous involvement will tend to express IL-17 more intensely.

Abstract Background: Livedoid vasculopathy (LV) manifests as ulcers and atrophic white scars on the lower extremities. The main known etiopathogenesis is hypercoagulability with thrombus formation, followed by inflammation. Thrombophilia, collagen and myeloproliferative diseases may induce LV, but the idiopathic (primary) form predominates. Bartonella spp. may cause intra-endothelial infection and skin manifestations caused by these bacteria may be diverse, including leukocytoclastic vasculitis and ulcers. Objective: The aim of this study was to investigate the presence of bacteremia by Bartonella spp. in patients with difficult-to-control chronic ulcers diagnosed as primary LV. Methods: Questionnaires and molecular tests (conventional PCR, nested PCR and real-time PCR) were applied and liquid and solid cultures were performed in the blood samples and blood clot of 16 LV patients and 32 healthy volunteers. Results: Bartonella henselae DNA was detected in 25% of LV patients and in 12.5% of control subjects but failed to reach statistically significant differences (p = 0.413). Study limitations: Due to the rarity of primary LV, the number of patients studied was small and there was greater exposure of the control group to risk factors for Bartonella spp. infection. Conclusion: Although there was no statistically significant difference between the groups, the DNA of B. henselae was detected in one of every four patients, which reinforces the need to investigate Bartonella spp. in patients with primary LV.

INTRODUCTION: The advent of squamous cell carcinomas (SCC) from chronic dermatoses is known but little explored. Although rare, tumors originating there have a worse prognosis, in part due to late diagnosis. OBJECTIVES: This study aims to survey cases of squamous cell carcinoma developed on previous dermatoses diagnosed between 2000 and 2020 in a tertiary health service. METHODS: This is a quantitative and retrospective study through biopsy reports survey and medical records review. RESULTS: From an initial list of 11,249 histological reports compatible with squamous cell carcinoma, we obtained a final list of 10 patients. The study findings corroborate the literature regarding some known risk factors: abundant and chronic sun exposure, older than 50 years, lower skin phototypes, and immunosuppression. We also found a high frequency of smoking and lichenoid dermatoses (5/10 patients) in the studied population, including chronic cutaneous lupus erythematosus and hypertrophic lichen planus. CONCLUSIONS: It is not possible to predict the primary risk factors for the development of squamous cell carcinomas regarding previous dermatoses, although there is a tendency for their appearance in lichenoid dermatoses and those with longer evolution.

Leprosy reactions are an acute inflammatory phenomenon that can arise before diagnosis, during treatment, or after cure of leprosy. These reactions are considered one of the main diseases that cause physical disabilities. Immunosuppressive treatment for these immune responses makes these patients susceptible to coinfections, which can trigger new leprosy reactions. The main objective of this study was to evaluate the occurrence of infection by Bartonella sp. in blood samples from 47 patients who had untreatable episodes of type 2 leprosy reactions for more than six months, comparing them with a control group. Cultures and molecular methods (PCR) were used. Amplicons from species-specific reactions and sequencing showed a higher prevalence of Bartonella henselae infection in patients, 19/47 (40.4 %), compared to control, 9/50 (18.0 %), p = 0.0149. Five patients accepted treatment for coinfection, and all showed improvement in leprosy reactions with treatment for B. henselae infection. We conclude that these bacteria can trigger chronic reactions of type 2 leprosy and should be investigated in these patients. Summary line: Patients who have chronic type 2 leprosy reactions are more susceptible to Bartonella henselae infection than controls: 19/47 (40.4 %) compared 9/50 (18.0 %), p = 0.0149.

Introdução: A hanseníase é uma doença milenar relacionada à pobreza, pois certas condições das populações menos favorecidas aumentam consideravelmente a exposição ao Mycobacterium leprae e ao Mycobacterium lepromatosis. Antes, durante ou mesmo após o término do tratamento para hanseníase, aproximadamente 30-50% dos pacientes desenvolvem reações inflamatórias agudas a antígenos micobacterianos, frequentemente localizados nos nervos periféricos. Essas reações inflamatórias são responsáveis pela maioria das deficiências físicas relacionadas a doenças infecciosas. Quando os pacientes apresentam reações hansênicas subsequentes, ou seja, por mais de seis meses, são considerados reações crônicas, sendo comum o envolvimento neural. Nesses casos, é necessário investigar fatores que possam atuar como desencadeadores dessas reações, incluindo coinfecções, ainda que subclínicas. A imunidade mediada por células Th1 desempenha um papel importante na evolução das infecções bacterianas intracelulares e, portanto, na evolução da hanseníase e suas reações. Há evidências de que a imunidade mediada por células também está intimamente relacionada com a patogênese e controle da infecção por Bartonella spp.. Essas bactérias podem causar infecção assintomática e são responsáveis por doenças emergentes e reemergentes. A coinfecção por B. henselae em paciente com reação hansênica crônica acompanhado na UNICAMP já foi descrita. Neste paciente houve melhora completa das reações com o tratamento para B. henselae. Objetivo: Avaliar a ocorrência de infecção por Bartonella sp. Em amostras de sangue de pacientes que tiveram episódios subintrantes de reações hansênicas tipo 2 por mais de seis meses, comparando-os com um grupo controle. Métodos: Foram utilizados métodos microbiológicos e moleculares (PCR) em amostras de sangue de pacientes de dois centros de referência para o tratamento da hanseníase no sudeste do Brasil. A evolução de pacientes com DNA de Bartonella sp. Detectado em um dos centros também foi observado. Resultados: Houve maior prevalência de infecção por Bartonella henselae em pacientes, 19/47 (40,4%), em comparação com o controle, 9/50 (18,0%), p = 0,0149. Cinco pacientes aceitaram o tratamento para coinfecção e todos apresentaram melhora das reações hansênicas com o tratamento da infecção por B. henselae. Conclusão: Conclui-se que essas bactérias podem desencadear reações crônicas da hanseníase tipo 2 e devem ser investigadas nesses pacientes.

Abstract Congenital and self-healing Hashimoto-Pritzker reticulohistiocytosis is the benign variant of the Langerhans cell histiocytosis (LCH) group. It is characterized by multiple skin lesions (congenital or appearing during the first days after birth), without systemic manifestations and spontaneous resolution in days to months. The authors report the case of a boy with a single congenital leg skin lesion, a rare disease variant. Through histopathology, a dense skin infiltration of S100 protein-, CD1a-, CD207-immunomarked cells was found. KI67 index was high (62%). A complete spontaneous resolution occurred 07 days after the biopsy (25 days after birth). Monolesional disease, distal limb lesion, absence of lesions in the mucous membrane or seborrheic area, and less than 25 percent of LCs with Birbeck granules were said to be possible clues for a favorable prognosis in LCs histiocytosis. But, as a precautionary measure, the child will be followed up until at least 2 years of age.

ABSTRACT BACKGROUND: The number of bariatric surgeries performed worldwide is growing. Among the main short, medium or long-term complications after surgery are nutritional deficiencies. Many of these, such as those of Zn, Cu and vitamins A, B1, B3, B6 and B12, are manifested by dermatological lesions before potentially fatal systemic disorders occur. OBJECTIVE: To identify the main dermatological manifestations associated with nutritional deficiencies after bariatric surgery, and the associated variables. DESIGN AND SETTING: Integrative literature review carried out at a public university in Brazil. METHODS: This was a case report and a review of health research portals and databases of national and international biomedical journals, without publication date limitation. The descriptors used for searches followed the ideal methodology for each database/search portal: “bariatric surgery”, “skin”, “skin disease”, “skin manifestation”, “deficiency disease” and “malnutrition”. RESULTS: A total of 59 articles were selected, among which 23 were review articles or articles that addressed specific dermatological manifestations. The other 36 articles described 41 cases, which were organized into a table with the clinical variables. CONCLUSIONS: Although nutritional deficiencies are expected as complications after bariatric surgery, few articles relating them to their dermatological manifestations were found. It is important to recognize skin changes caused by nutritional deficiencies in patients treated via bariatric surgery, as these may occur before systemic complications appear and are easier to diagnose when the patient does not have any systemic symptoms yet. However, there is generally a delay between the appearance of skin lesions and making the diagnosis of nutritional deficiency.

ABSTRACT As leprosy and leprosy reactions are the most prevalent infectious cause of physical disability, it is important to commit efforts to better understand these chronic reactions. Infections, even when asymptomatic, can trigger leprosy reactions and Bartonella spp. in turn, can cause chronic infections. We presented a case of a 51-year-old man who was admitted presenting with chronic type 2 leprosy reactions. He had a lepromatous form of leprosy that was histologically diagnosed six months after the onset of signs and symptoms compatible with a chronic type 2 reaction. He reported a history of a previous hepatitis B diagnosis. During a 24-month multidrug therapy (MDT), chronic reactions were partially controlled with prednisone and thalidomide. Thirty-three months following the leprosy treatment, he still experienced chronic reactions, and whole bacilli as well as globi were found on a new skin biopsy. Since coinfections can trigger type 2 reactions and the patient had close contact with animals and ticks, we investigated the presence of a Bartonella sp. infection. Bartonella henselae DNA was detected in a skin fragment obtained before the beginning of the leprosy retreatment. However, even after six months of a second leprosy MDT, he continued to experience type 2 chronic reactions. He was admitted to the hospital to undergo an intravenous antibiotic therapy for 14 days and then complete the treatment per os for ten more weeks. Leprosy reactions improved following the treatment for B. henselae. After completing the MDT treatment, he has been accompanied for sixty months with no signs of leprosy or leprosy reactions. The asymptomatic infection by B. henselaein this patient was considered the putative trigger of chronic leprosy reactions and leprosy relapse.

Abstract Topical use of immune response modifiers, such as imiquimod, has increased in dermatology. Although its topical use is well tolerated, it may be associated with exacerbations of generalized cutaneous inflammatory diseases, possibly through the systemic circulation of pro-inflammatory cytokines. This report describes a case of development of pityriasis rubra pilaris, a rare erythematous-papulosquamous dermatosis, in a woman aged 60 years during treatment with imiquimod 5% cream for actinic keratosis. It evolved with erythrodermic conditions and palmoplantar keratoderma, presenting progressive clinical resolution after the introduction of methotrexate. The authors emphasize the importance of recognizing possible systemic reactions associated with the topical use of imiquimod.

RESUMO Objetivo: Descrever a evolução clínica do nevo de Spitz, desde sua característica inicial plana até o aparecimento de uma superfície irregular, nodular e avermelhada e a conduta perante essas alterações. Descrição do caso: Criança do sexo feminino, fototipo II, com um pequeno nevo congênito na perna esquerda e outros pequenos nevos adquiridos. Paciente passou por avaliações anuais clínicas e dermatoscópicas para controle entre 3 e 7 anos de idade, quando um desses nevos, localizado na coxa esquerda, apresentou crescimento rápido. A hipótese clínica foi nevo de Spitz, com indicação de remoção cirúrgica com margem de segurança e posterior análise anatomopatológica. Considerando a idade da paciente e os aspectos clínicos e histológicos, a lesão foi diagnosticada como nevo de Spitz. Comentários: Uma lesão de padrão dermatoscópico globular e menor que 5 mm permitia acompanhamento clínico, porém a hipercromia, a estética local, o crescimento rápido, a possibilidade de trauma na região e os riscos de transformação maligna na puberdade nortearam a decisão de remoção total e posterior acompanhamento para monitorar qualquer recidiva.

INTRODUCTION: Little is known about ethnic differences in the frequency of skin diseases, and even less in terms of Brazilian population, which is characterized by miscegenation. OBJECTIVE: To evaluate the distribution of skin disorders in black and Caucasian patients through pathological specimens. METHODS: 826 biopsies from black-skinned individuals and 1,652 from white-skinned patients were retrieved and studied from the files of the Pathology Department, UNICAMP Hospital within the period of 1993-2009. The clinical data were obtained from medical records and the results were tested by statistical methods. RESULTS: Non-melanoma cancer was the most frequent diagnosis in Caucasians (45%), differing from the frequency among black patients (8%), both arising in sun-exposed skin. Regarding topography and age, in white-skinned patients aged over 50 years, biopsies of "head and neck" prevailed. As to black patients, the disease predominated among female individuals aged from 15 to 50 years and in the genital area. In the comparative analysis of vulvar diseases, we observed differences in diagnoses of sexually transmitted diseases more common among black women. Excluding cancers and genital lesions, black patients had a higher percentage of infectious diseases. Among the non-infectious diseases, cutaneous lupus was the most frequent diagnosis in both groups. Lichen planus and drug reactions were more frequent in black patients. CONCLUSION: Apart from intrinsic differences among skin types, social factors may interfere in the distribution of diseases. Not only may these results be useful to public health programs, but they may also aid the approach to dermatological diseases in black skin patients.

OBJECTIVE: To demonstrate the role of angiogenesis in the progression of cutaneous squamous cell carcinoma. INTRODUCTION: Angiogenesis is a pivotal phenomenon in carcinogenesis. Its time course in cutaneous squamous cell carcinoma has not yet been fully established. METHODS: We studied the vascular bed in 29 solar keratoses, 30 superficially invasive squamous cell carcinomas and 30 invasive squamous cell carcinomas. The Chalkley method was used to quantify the microvascular area by comparing panendothelial (CD34) with neoangiogenesis (CD105) immunohistochemical markers. The vascular bed from non-neoplastic adjacent skin was evaluated in 8 solar keratoses, 10 superficially invasive squamous cell carcinomas and 10 invasive squamous cell carcinomas. RESULTS: The microvascular area in CD105-stained specimens significantly increased in parallel with cutaneous squamous cell carcinoma progression. However, no differences between groups were found in CD34 sections. Solar keratosis, superficially invasive squamous cell carcinoma and invasive squamous cell carcinoma samples showed significant increases in microvascular area for both CD34- and CD105-stained specimens compared with the respective adjacent skin. DISCUSSION: The angiogenic switch occurs early in the development of cutaneous squamous cell carcinoma, and the rate of neovascularization is parallel to tumor progression. In contrast to panendothelial markers, CD105 use allows a dynamic evaluation of tumor angiogenesis. CONCLUSION: This study demonstrated the dependence of skin carcinogenesis on angiogenesis.

FUNDAMENTOS: Estudos epidemiológicos têm demonstrado relação significativa entre nevos melanocíticos e melanoma cutâneo. OBJETIVO: Acompanhar o desenvolvimento de nevos melanocíticos nos alunos de uma escola composta, majoritariamente, por descendentes de holandeses e a influência do meio ambiente sobre esses indivíduos com características fenotípicas semelhantes às de seus antepassados. MÉTODOS: Em 1999, iniciou-se estudo coorte para contagem de nevos melanocíticos nos 282 alunos entre três e 17 anos, sendo 53,9% meninos. Após cinco anos, realizou-se novo exame em 148 alunos entre oito e 22 anos, dos quais 49,3% eram meninos. Analisou-se a relação da idade, sexo, fotótipo, cor dos olhos, cor dos cabelos e etnia dos alunos e dos pais com a presença de nevos melanocíticos no início e no final do estudo. RESULTADOS: Houve aumento significativo de nevos melanocíticos e nevos displásicos no reexame. Os meninos tiveram mais nevos melanocíticos (áreas cobertas e expostas) do que as meninas. A análise de probabilidade para razão de risco revelou que os meninos têm mais chance de desenvolver nevos melanocíticos do que as meninas, assim como os de etnia não miscigenada e miscigenada e com cabelos claros têm mais que os alunos de outras etnias e com cabelos escuros. Os que apresentam fotótipo I são mais propensos a desenvolver nevos melanocíticos nas áreas cobertas do que os que têm fotótipos II e III. CONCLUSÕES: Os dados demonstram que os indivíduos de etnia holandesa tiveram maior probabilidade de desenvolver nevos melanocíticos do que os outros grupos étnicos.BACKGROUNDS: Epidemiological studies have shown a significant relationship between melanocytic nevi and cutaneous melanoma. OBJECTIVE: To evaluate the development of melanocytic nevi in the pupils of a school composed primarily of children of Dutch descent and to assess the effect of environmental factors on these individuals whose phenotypic characteristics were similar to those of their ancestors. METHODS: In 1999 a cohort study was initiated to count the number of melanocytic nevi in 282 pupils of 3 to 17 years of age, 53.9% of whom were boys. Five years later a repeat exam was conducted in 148 students of 8 to 22 years of age, 49.3% of whom were males. The association between the age, skin phototype, eye color, hair color and ethnic group of the pupils and their parents and the presence of melanocytic nevi was analyzed at the beginning and at the end of the study. RESULTS: There was a significant increase in cases of melanocytic nevi and dysplastic nevi at the follow-up examination. The number of melanocytic nevi was greater in boys than in girls in both covered and exposed areas of skin. Likelihood analysis calculated using the odds ratio showed that boys were more likely to develop melanocytic nevi than girls and that the children of non-mixed and mixed race with lighter hair were more likely to develop melanocytic nevi than those of other ethnic groups and those with dark hair. Children with skin phototype I were more likely to develop melanocytic nevi in covered areas of skin compared to those with skin types II or III. CONCLUSIONS: These data show that individuals of Dutch descent were more likely to develop melanocytic nevi than individuals of other ethnic origins.

Várias dermatoses são consideradas idiopáticas. Muitas vezes, afecções como eritema nodoso ou eritema multiforme, por exemplo, não podem ter sua etiologia definida. A infecção humana por Bartonella spp. pode determinar várias expressões clínicas sindrômicas. A partir de um caso de angiomatose bacilar com documentação clínica, histológica e ultra-estrutural, foi feita a revisão da literatura médica para avaliar os critérios diagnósticos disponíveis para a infecção por esses agentes. Conclui-se que a avaliação histológica é, na prática, um importante e útil método diagnóstico, especialmente quando a sorologia não estiver disponível.Several dermatoses are considered idiopathic diseases. Many times lesions such as erythema nodosum or erythema multiformis, for example, cannot have their etiology defined. Human infection caused by Bartonella spp. may determine several clinical syndromic expressions. Starting with a clinically, histologically and ultrastructurally documented bacillary angiomatosis case, a review of medical literature was undertaken to evaluate the available diagnostic criteria regarding infection caused by these agents. Histological evaluations were concluded to be, practically speaking, an important and useful diagnostic method, especially when serology is not available.

A angiomatose bacilar é uma das bartoneloses humanas. É doença sistêmica de manifestação cutânea freqüente. Caracteriza-se por lesões angioproliferativas causadas pela Bartonella henselae e pela B. quintana, que comprometem especialmente indivíduos imunodeficientes. Deve ser bem conhecida pelos dermatologistas, pois é potencialmente fatal, mas responsiva à antibioterapia. Para estabelecer o diagnóstico nosológico eles deverão sugeri-lo ao anatomopatologista, facilitando a diferenciação histológica, sobretudo, com o granuloma piogênico e o sarcoma de Kaposi. O presente artigo apresenta revisão da literatura e fotografias clínicas, de microscopia de luz e eletrônica de transmissão.Bacillary angiomatosis is one of the human bartoneloses. It is a systemic disease usually affecting the skin. Its angioproliferative lesions are caused by B. henselae and by B. quintana. Such lesions are more frequent in immunodeficient hosts. Dermatologists must be well aware of this disease because it is potentially fatal, though it is treatable with antibiotic therapy. To establish a nosologic diagnosis, dermatologists should refer patients to a pathologist. In so doing, they will facilitate histologic differentiation especially from pyogenic granuloma and Kaposi's sarcoma. This paper presents a literature review of the disease, and includes clinical, light and transmission electron microscope photographs.

Doença de Bowen designa carcinoma in situ cuja evolução é lenta e progressiva, geralmente assintomática. Na região perianal essa lesão é pouco freqüente, ocorrendo mais em indivíduos jovens. Quando acomete áreas que não sofreram exposição solar, outros fatores podem estar associados, como HPV, doenças inflamatórias ou neoplasias de cólon. A doença pode ser tratada com cirurgia convencional, criocirurgia ou terapia fotodinâmica. O objetivo é relatar um raro caso clínico da doença de Bowen, em paciente do sexo feminino, jovem, negra, que apresentava uma extensa lesão na região perianal com positividade para HPV. A paciente estava em tratamento para retocolite ulcerativa com suspeita de ter, associadamente, doença de Crohn. Foi tratada com criocirurgia e evoluiu com boa cicatrização do local, sem apresentar sinais de recidiva 34 meses após o tratamento.Bowen's disease is generally an asymptomatic in situ carcinoma that develops slowly. It rarely occurs in the genital region and mainly affects young persons. Skin lesions occurring in areas not exposed to sunlight may be associated with other factors, like HPV, inflammatory disease or colon neoplasia. The disease may be treated by conventional surgery, cryosurgery or photodynamic therapy. The aim is to present the clinical characteristics of a rare case of Bowen's disease in a young, black female, who had a large lesion in the perianal region, which tested positive for HPV. The woman had been undergoing treatment for intestinal ulcerative rectocolitis or Crohn's disease. She was treated with cryosurgery and there was no sign of recurrence during the ensuing 34 months.

A medicina tem sido representada, nas mais diversas expressões artísticas, desde as culturas primitivas até os dias atuais, com considerável grau de variedade e evolução, de acordo com áreas geográficas e heranças históricas, nas diferentes sociedades. Sempre houve preocupação com o registro da figura humana, seja no seu esplendor, seja no estado de morbidade. Os autores expõem registros de expressões dermatológicas nas pinturas europeias.Medicine has been represented in the most diverse artistic expressions, from primitive cultures to present days, with a considerable degree of variety and evolution, according to the geographical areas and the historic heritage in different societies. There has always been concern regarding recording of the human figure, be it in its splendor, be it at morbidity condition. The authors present illnesses with dermatological expression in European paintings.

Apresenta-se caso clínico de dermatite de contato e reação a distância por contato com mercúrio elementar.Paciente apresentou eritema, edema e vesículas após contato dérmico com mercúrio. Lesões evoluíram para placas eritematosas com pequenas áreas enegrecidas sugerindo necrose e vesículas secas. Ocorreram lesões eritematosas a distância no tórax, abdômen e face flexora do cotovelo. Dosagem de Hg na urina 36 horas após início do contato foi de 5,9µg/L, e no sétimo dia 19,6µg/L, indicando absorção através da pele inflamada. Lesões dermatológicas por contato direto por mercúrio metálico elementar devem ser esperadas em casos acidentais.A clinical case of contact dermatitis following direct skin contact with elemental mercury is presented. Patient had metal mercury in contact with extensive part of his leg and foot skin resulting in erythematous, edematous, and vesicular dermatitis. Lesions evolved to erythematous plaques with small scattered areas of necrosis and drying vesicle lesions. Distant lesions appeared in the right forearm, chest and abdomen. Urinary mercury 36h after contact was 5.9 µg/L, and one week later 19.6 µg/L, indicating dermal absorption. dermal absorption. Dermal effects due to elemental mercury must be expected after direct skin contact.

A tungíase é uma infestação zooantropofílica causada pela Tunga penetrans. É endêmica na América Latina e no Caribe. Ocorre, principalmente, em comunidades carentes e sem saneamento básico e em indivíduos que visitam áreas contaminadas. O local mais comum de penetração do ectoparasita é a região periungueal dos pés. Os autores mostram a ocorrência de uma forma disseminada num habitante da zona rural.Tungiasis is a zoophilic and anthropophilic infestation caused by Tunga penetrans. It is endemic in Latin America and in the Caribbean. It occurs mainly in impoverished communities that have no access to basic sanitation and in individuals that visit contaminated areas. The most common penetration site of this ectoparasite is the periungueal region of the feet. The authors present its disseminated form occurring in a patient inhabiting a rural area.

A rinosporidiose é uma doença infecciosa zooantropofílica mucocutânea causada pelo Rhinosporidium seeberi. Caracteriza-se por massa polipoide, séssil ou pedunculada, eritematosa, moriforme e friável, principalmente, nas mucosas nasais e oculares. A ocorrência na pele é ocasional, por disseminação a partir da mucosa adjacente, inoculação direta ou generalização via hematogênica. Os autores apresentam o caso clínico de um menino de oito anos de idade, com lesão isolada localizada no epicanto medial do olho direitoRhinosporidiosis is an infectious mucocutaneous disease caused by Rhinosporidium seeberi. It is characterized by sessile or pedunculated polyps which are erythematous, moriform and friable and which mainly affect the ocular and nasal mucosa. The occurrence of skin lesions is occasional and due to dissemination from the adjacent mucosa, direct inoculation or hematogenous dissemination. The authors report the clinical case of an eight-year-old boy with an isolated lesion located in the medial epicanthus of the right eye

A descoberta do Treponema pallidum por Schaudinn & Hoffmann em 3 de março de 1905 foi influenciada pela comunicação de Siegel, sobre a descoberta do agente etiológico da sífilis. Encarada com ceticismo, a comunicação acarretou novas investigações, conduzidas pelo zoologista Schaudinn e pelo dermatologista Hoffmann -primeiros observadores do agente da sífilis, denominado Spirochaeta pallida. A descoberta foi o passo inicial para o desenvolvimento dos procedimentos diagnósticos e terapêuticos nos anos subseqüentes.The discovery of Treponema pallidum by Schaudinn & Hoffmann, on March 3rd 1905, was influenced by Siegels' communication on the finding of the etiological agent of syphilis. John Siegel, working at the Institut of Zoology, University of Berlin, claimed to have found a flagellate protozoon in syphilitic lesions. Because of the skepticism it was received with, this communcation yielded further investigation, conducted by zoologist Schaudinn and dermatologist Hoffmann. They were the first investigators to find the etiological agent of syphilis, described under the name of Spirochaeta pallida. The discovery of Treponema pallidum on March 3rd 1905 was the first step towards the development of diagnostic and therapeutic procedures in subsequent years.

Donovanosis is a chronic bacterial illness frequently associated with sexually transmitted infections (STI) and is under diagnosed both in endemic areas as well as in countries in which doctors have little experience with tropical diseases. The utilization of syndromic diagnosis and treatment of STIs in various parts of the world and the previous use of antibiotics make it difficult to find Donovan bodies in the cytodiagnostic and hystopathological exams, requiring the utilization of technology that is neither routine nor often accessible to confirm the hypothesized diagnosis. Therefore, it is necessary to bring medical professionals up to date about this infectious disease.

A histopathological study of a distinct papule isolated from a patient's neck is reported and compared to 80 melanocytic nevi. The histogenesis of this unique tumor indicates that it probably represents the residual of a melanocytic nevus in wich nevi cells have disappeared but fat infiltration and fibrosis of the dermis and the typical aspects of other cutaneous elements persisted. The finding of focal acantholytic dyskeratosis in multiple foci of the lesion may indicate melanocytic cells regression. Lesions with the histopathological appearence of melanocytic nevi, even in the absence of nevi cells, may be discovered scrutinizing the associated alterations.

Multibacillary, lepromatous or borderline leprosy patients may present two types of vasculonecrotic reactions: Lucio phenomenon and that associated with erythema nodosum leprosum. Despite they can be distinguished through clinical and histological characteristics; both are often used as synonyms. It is said that leprosy reaction should be properly classified for therapeutic reasons, since it is well known that in Lucio phenomenon there is not a good response to thalidomide. The authors reported two cases of vasculonecrotic phenomena in lepromatous leprosy sharing clinical and histopathological characteristics of both reaction subtypes. The findings may indicate the spectral nature of the reaction phenomena in leprosy and emphasize the importance of the clinic-pathological correlation for proper classification. Our findings may contribute to the understanding of leprosy reactions pathogenesis, broaden the knowledge about their outcome with standard treatment, and provide the scientific background to design better therapeutic strategies for these complications.

CONTEXT: Non-specific lymphocytic infiltrates of the skin pose difficulties in daily practice in pathology. There is still a lack of pathognomonic signs for the differential diagnosis between benign and malignant lymphocytic infiltrates. OBJECTIVE: To evaluate the morphological and immunohistochemical profile of lymphocytic infiltrations of the skin according to clinical outcome. TYPE OF STUDY: Retrospective; histopathological and immunohistochemical analysis. SETTING: Referral center, university hospital. SAMPLE: 28 cases of lymphocytic infiltrates of difficult differential diagnosis selected from the records. MAIN MEASUREMENTS: Eighteen histological variables and the immunophenotypic profile were assessed using the CD4, CD8, CD3, CD20 and CD30 lymphoid markers and compared to subsequent follow-up. RESULTS: The most common diagnoses were: initial mycosis fungoides (eight cases) and drug reactions (five cases). Single morphological variables did not discriminate between benign and malignant infiltrates except for the presence of Pautrier-Darier's microabscesses, which were found only in mycosis fungoides (p = 0.015). Patterns of superficial and deep infiltration (p = 0.037) and also the presence of eosinophils (p = 0.0207) were more frequently found in benign lymphocytic infiltrates. Immunohistochemical profile of T-cell subsets showed overlap between benign and malignant infiltrates with a predominance of CD4-positive (helper) lymphocytes in the majority of cases. CONCLUSIONS: A combination of clinical and histological features remains the most reliable approach for establishing a definite diagnosis in cases of lymphoid skin infiltrates.